Association between gross motor function (GMFCS) and manual ability (MACS) in children with cerebral palsy. A population-based study of 359 children

Katharina Delhusen Carnahan, Marianne Arber & Gunnar Hagglund

The Gross Motor Function Classification System (GMFCS) has become an important tool to describe motor function in children with Cerebral Palsy (CP); recently The Manual Ability Classification System (MACS) has been developed as a corresponding classification measuring manual ability. The aim of this study is to describe the association between gross motor function and manual ability in a population of children with CP. The sample consisted of 365 children, born between 1992 and 2001, who were registered in a population-based health care programme (CPUP) for children with CP living in the south of Sweden. GMFCS was then evaluated by the child's physiotherapist and MACS by the occupational therapist.

GMFCS levels were available in all 365 children, however MACS levels were only available in 359 (98%). There was a poor overall correlation between gross motor function and manual ability. Different associations between gross motor function and manual ability were found in the different diagnostic subtypes, which had been determined by a neurophysician at age 4 years old.

Children with spastic hemiplegia had a lower level of manual ability than gross motor function (p<0.001). The reverse association was found in children with spastic diplegia (p<0.001). Children with dyskinetic CP had large limitations in both gross motor function and manual ability, with no significant difference between GMFCS and MACS levels. However to give a complete clinical picture when examining these children, both aspects should be described. The GMFCS and the MACS seemed to work well in this context and seem very useful in population-based studies, in health care registers for children with CP, and in clinical practice.

BMC Musculoskeletal Disorders 2007, 8(50).

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